Facts
- Status
- A
- Credential
- CMT
- Type
- Individual
- Enumeration date
- 2021-04-24
- Last updated
- 2022-11-10
Specialties
Licenses
- License CA
- 73714
Location
- Practice location
- 6735 WESTMINSTER BLVD STE 107
- City
- WESTMINSTER CA
- Postal code
- 926833772
- Phone
- 310-415-6487
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.